Wiki Surrogacy Insurance

[lacey.kirby@gfobgyn.com]

Good afternoon,

I am a new Office Manager and I have a scenario that has come up that I haven't encountered yet, and wanted to see if anyone else had more knowledge on this. We have an established patient with our office that has a Tricare Reserve Select (she is the sponsor) as her primary policy, as well as a commercial BCBS through her husband for her secondary. She has chosen to become a surrogate and will be seen in our office for this pregnancy. She has now enrolled in a BCBS policy under herself specifically for this surrogacy and the patient feels very strongly that we are not to bill her other insurances first because of the type of BCBS policy she signed up for. It feels wrong to not bill the other insurances, when we are aware of them. I did try reaching out to BCBS and the waters were further muddied for me..

Thank you so much for any help, I really appreciate it!

Lacey K

 

[sls314]

Good afternoon,

I am a new Office Manager and I have a scenario that has come up that I haven't encountered yet, and wanted to see if anyone else had more knowledge on this. We have an established patient with our office that has a Tricare Reserve Select (she is the sponsor) as her primary policy, as well as a commercial BCBS through her husband for her secondary. She has chosen to become a surrogate and will be seen in our office for this pregnancy. She has now enrolled in a BCBS policy under herself specifically for this surrogacy and the patient feels very strongly that we are not to bill her other insurances first because of the type of BCBS policy she signed up for. It feels wrong to not bill the other insurances, when we are aware of them. I did try reaching out to BCBS and the waters were further muddied for me..

Thank you so much for any help, I really appreciate it!

Lacey K

You should still have to follow standard Coordination of Benefits. She can't pick and choose which plan is primary just based on her preference.

Now, it may be that her other 2 plans exclude services related to surrogacy Or maybe this particular BCBS plan would end up being primary for her with Coordination of Benefits anyhow.

I agree with you that I'd want proper clarification though to ensure that I was billing correctly.

 

[nielynco]

Good afternoon,

I am a new Office Manager and I have a scenario that has come up that I haven't encountered yet, and wanted to see if anyone else had more knowledge on this. We have an established patient with our office that has a Tricare Reserve Select (she is the sponsor) as her primary policy, as well as a commercial BCBS through her husband for her secondary. She has chosen to become a surrogate and will be seen in our office for this pregnancy. She has now enrolled in a BCBS policy under herself specifically for this surrogacy and the patient feels very strongly that we are not to bill her other insurances first because of the type of BCBS policy she signed up for. It feels wrong to not bill the other insurances, when we are aware of them. I did try reaching out to BCBS and the waters were further muddied for me..

Thank you so much for any help, I really appreciate it!

Lacey K

According to Tricare rules (and as she is a Tricare beneficiary she has already checked and this is why she is telling you not to bill them as primar)y:

TRICARE coverage for surrogacy health care is a limited benefit. TRICARE pays second for services and supplies related to maternity care, including antepartum care, childbirth, postpartum care, and complications of pregnancy for a surrogate mother who:

• Is a TRICARE beneficiary
• Has a contractual agreement with the adoptive parents

The medical expenses agreed to in the contract are considered primary coverage.

• TRICARE pays second after the surrogate mother seeks reimbursement from the adoptive parents.
• Any amount designated for medical expenses under the contract must be exhausted before TRICARE will cover other covered benefits for the surrogate mother.
• If the contract doesn’t specify a reasonable amount for reimbursement for medical expenses, the surrogate mother will pay a reasonable amount of the expenses.

Without a contract, TRICARE doesn’t cover maternity services provided to a TRICARE beneficiary acting as a surrogate.